Understanding the ICD-10-PCS Guidelines - ACSS

Preparing for ICD-10: 

Understanding the ICD-10-PCS 

Guidelines 

Nelly Leon-Chisen, RHIA 

Director, Coding and Classification

Learning Objectives 

• Learn the General ICD-10-PCS Coding Guidelines 

• Understand the ICD-10-PCS Coding Guidelines for the 

Medical and Surgical Section including: 

– Body system guidelines 

– Root operation guidelines 

– Body part guidelines 

– Approach guidelines 

– Device guidelines 

• Review surgical examples from Coding Clinic for ICD-9-CM 

applying the ICD-10-PCS Coding Guidelines 

Copyright (c) 2010 by American Hospital Association. All rights reserved. 

2

Guideline Organization 

A. Conventions 

B. Medical and Surgical section guidelines 

2. Body system guidelines 

3. Root operation guidelines 

4. Body part guidelines 

5. Approach guidelines 

6. Device guidelines 

C. Other medical and surgical-related sections 


3

Conventions: A1 

ICD-10-PCS codes are composed of seven characters. Each 

character is an axis of classification that specifies information 

about the procedure performed. Within a defined code range, a 

character specifies the same type of information in that axis of 

classification. 

1 2 3 4 5 6 7 

Section 

Root 

Operation 

Approach 

Device 

Qualifier 

Body 

System 

Body Part 


4


One of 34 possible values can be assigned to each axis of 

classification in the seven-character code: they are the 

numbers 0 through 9 and the alphabet (except I and O 

because they are easily confused with the numbers 1 and 0). 

The number of unique values used in an axis of classification 

differs as needed. 

Approach Examples: 

0 Open 

2 Open endoscopic 

3 Percutaneous 

4 Percutaneous endoscopic 

7 Via natural or artificial opening 

8 Via natural or artificial opening endoscopic 

X External 


5


The valid values for an axis of classification can be added to 

as needed. 

Example: If a significantly distinct type of device is used in a 

new procedure, a new device value can be added to the 

system. 


6


As with words in their context, the meaning of any single 

value is a combination of its axis of classification and any 

preceding values on which it may be dependent. 

Examples: 

• Body part value 0 in Central Nervous System = Brain 

00B00ZX Excision of Brain, Open Approach, Diagnostic 

• Body part value 0 in Peripheral Nervous Body System = Cervical 

Plexus 

01B00ZX - Excision of Cervical Plexus, Open Approach, 

Diagnostic 


7

Example 

0 0 B 0 0 Z X 

Section 

Root 

Operation 

Approach 

Qualifier 

Medical 

and 

Surgical 

Body 

System 

Central 

Nervous 

System 

Excision 

Body Part 

Brain 

Open 

Device 

No device 

Diagnostic 

Example: 

• Body part value 0 in Central Nervous System = Brain 

00B00ZX Excision of Brain, Open Approach, Diagnostic 


8

Example 

0 1 B 0 0 Z X 

Section 

Root 

Operation 

Approach 

Qualifier 

Medical 

and 

Surgical 

Body 

System 

Peripheral 

Nervous 

System 

Excision 

Body Part 

Cervical 

Plexus 

Open 

Device 

No device 

Diagnostic 

• Body Part value 0 in Peripheral Nervous Body System = Cervical Plexus 

01B00ZX - Excision of Cervical Plexus, Open Approach, Diagnostic 


9


As the system is expanded to become increasingly detailed, 

over time more values will depend on preceding values for 

their meaning. 

Example: In the Lower Joints body system, the device value 3 in 

the root operation Insertion specifies Infusion Device and the 

device value 3 in the root operation Fusion specifies Interbody 

Fusion Device. 


10

Conventions: A6 – A9 

The purpose of the alphabetic index is to locate the appropriate 

table that contains all information necessary to construct a 

procedure code. The PCS Tables should always be consulted to 

find the most appropriate valid code. 

It is not required to consult the index first before proceeding to the 

tables to complete the code. A valid code may be chosen directly 

from the tables. 

All seven characters must be specified to be a valid code. If the 

documentation is incomplete for coding purposes, the physician 

should be queried for the necessary information. 

Within a PCS table, valid codes include all combinations of choices 

in characters 4 through 7 contained in the same row of the table. 


11

Sample Alphabetical Index Entries 


12

Sample Alphabetical Index Entries (cont.) 


13

Sample ICD-10-PCS Table 


14

Conventions: A10 

“And,” when used in a code description, means “and/or.” 

Example: Lower Arm and Wrist Muscle means lower arm 

and/or wrist muscle. 


15


Many of the terms used to construct PCS codes are defined 

within the system. It is the coder’s responsibility to 

determine what the documentation in the medical record 

equates to in the PCS definitions. The physician is not 

expected to use the terms used in PCS code descriptions, 

nor is the coder required to query the physician when the 

correlation between the documentation and the defined PCS 

terms is clear. 


16

Example 

• Example: When the physician documents “partial resection” 

the coder can independently correlate “partial resection” to 

the root operation Excision without querying the physician 

for clarification. 


17

Guideline Organization 

A. Conventions 

B. Medical and Surgical section guidelines 

2. Body system guidelines 

3. Root operation guidelines 

4. Body part guidelines 

5. Approach guidelines 

6. Device guidelines 

C. Other medical and surgical-related sections 


18

Body System: General Guidelines 

B2.1a 

The procedure codes in the general anatomical regions 

body systems should only be used when the procedure is 

performed on an anatomical region rather than a specific 

body part (e.g., root operations Control and Detachment, 

drainage of a body cavity) or on the rare occasion when no 

information is available to support assignment of a code to a 

specific body part. 

Example: Control of postoperative hemorrhage is coded to the 

root operation Control found in the general anatomical regions 

body systems. 


19

Body System General Guidelines (cont.) 

B2.1b 

Body systems designated as upper or lower contain body 

parts located above or below the diaphragm respectively. 

Example: Vein body parts above the diaphragm are found in the 

Upper Veins body system; vein body parts below the diaphragm 

are found in the Lower Veins body system. 


20

Root Operation: General Guidelines 

B3.1a 

In order to determine the appropriate root operation, the full 

definition of the root operation as contained in the PCS 

Tables must be applied. 


21

Root Operation: General Guidelines (cont) 

B3.1b 

Components of a procedure specified in the root operation 

definition and explanation are not coded separately. 

Procedural steps necessary to reach the operative site and 

close the operative site are also not coded separately. 

Example: Resection of a joint as part of a joint replacement 

procedure is included in the root operation definition of 

Replacement and is not coded separately. Laparotomy 

performed to reach the site of an open liver biopsy is not 

coded separately. 


22

Example 


23

Root Operation Guidelines: Multiple 

Procedures 

B3.2 During the same operative episode, multiple procedures 

are coded if: 

a. The same root operation is performed on different body 

parts as defined by distinct values of the body part 

character. 

b. The same root operation is repeated at different body 

sites that are included in the same body part value. 

c. Multiple root operations with distinct objectives are 

performed on the same body part. 

d. The intended root operation is attempted using one 

approach, but is converted to a different approach. 


24


Procedures (cont) 

• The same root operation is performed on different body 

parts as defined by distinct values of the body part 

character. Example: Diagnostic Excision of liver and 

pancreas 


25

Coding Clinic Example 

Question: 

Our surgeons are now performing total laparoscopic 

hysterectomies. These types of surgeries are distinct from the 

laparoscopic assisted vaginal hysterectomies. A patient 

underwent total laparoscopic hysterectomy and laparoscopic 

bilateral salpingo-oophorectomy. What is the correct procedure 

code assignment for total laparoscopic hysterectomy (TLH)? 

Answer: 

Assign code 68.41, Laparoscopic total abdominal hysterectomy, 

for the TLH. Code 65.63, Laparoscopic removal of both ovaries 

and tubes at the same operative episode, should be assigned for 

the bilateral laparoscopic salpingo-oophorectomy. 

Coding Clinic, Fourth Quarter 2006 Pages 130-134 


26

ICD-9-CM vs. ICD-10-PCS 

ICD-9-CM 

• 68.41 Laparoscopic total 

abdominal hysterectomy 

• 65.63 Laparoscopic removal of 

both ovaries and tubes at the 

same operative episode 

ICD-10-PCS 

• 0UT94ZZ Resection of Uterus, 

Percutaneous Endoscopic 

Approach 

• 0UT24ZZ Resection of 

Bilateral Ovaries, 


Approach 

• 0UT74ZZ Resection of 

Bilateral Fallopian Tubes, 


Approach 


27



The same root operation is repeated at different body sites that are 

included in the same body part value. Example: Excision of the 

sartorius muscle and excision of the gracilis muscle. 


28



Multiple root operations with distinct objectives are performed on the 

same body part. Example: Destruction of sigmoid lesion and bypass 

of sigmoid colon are coded separately. 


29



The intended root operation is attempted using one approach, but is 

converted to a different approach. Example: Laparoscopic 

cholecystectomy converted to an open cholecystectomy is coded as 

percutaneous endoscopic Inspection and open Resection. 


30


Question: 

A patient is taken to the operating room for laparoscopic 

cholecystectomy for an acute and chronic cholecystitis. During the 

procedure, the surgeon decides that a laparoscopic approach is not 

safe because dissection was too difficult due to previous abdominal 

surgery scarring. An open cholecystectomy is then carried out 

uneventfully. What are the appropriate codes for this situation? 

Answer: 

Assign codes 575.12, Acute and chronic cholecystitis; V64.4, 

Laparoscopic surgical procedure converted to open procedure; and 

51.22, Cholecystectomy. It is inappropriate to assign code 51.23, 

Laparoscopic cholecystectomy, since the definitive procedure was the 

open one. 

Coding Clinic, Fourth Quarter 1997 Page: 52 


31



• 51.22 Cholecystectomy 


• 0FJ44ZZ Inspection, 

Gallbladder, Percutaneous 

Endoscopic, No Device, No 

Qualifier 

• 0FT40ZZ Resection, 

Gallbladder, Open, No Device, 

No Qualifier 


32

Root Operation Guidelines: Discontinued 

Procedures 

B3.3 

If the intended procedure is discontinued, code the 

procedure to the root operation performed. If a procedure is 

discontinued before any other root operation is performed, 

code the root operation Inspection of the body part or 

anatomical region inspected. 


33


Other than the code for failed forceps, ICD-9-CM Procedure 

Classification does not have specific codes to designate 

procedures that could not be successfully completed. The general 

coding rule is to code the extent of the procedure carried out. 

Example: Transurethral approach for removal of ureteral stone 

with unsuccessful attempt to pass endoscope to site of stone in 

ureter and, therefore, no manipulation of stone. Code as ureteral 

endoscopy if the endoscope was passed into the ureter, 56.31; 

otherwise, code as a cystoscopy. 

Coding Clinic, March - April 1985 Pages: 13-14 


34



• 56.31 Ureteroscopy 


• 0TJ68ZZ Inspection of Right 

Ureter, Via Natural or Artificial 

Opening Endoscopic 

Or 

• 0TJ78ZZ Inspection of Left 

Ureter, Via Natural or Artificial 

Opening Endoscopic 

Or 

• 0TJ88ZZ Inspection of 

Bilateral Ureters, Via Natural or 

Artificial Opening Endoscopic 


35

Root Operation Guidelines: Biopsy Followed by 

More Definitive Treatment 

B3.4 

If a diagnostic Excision, Extraction, or Drainage procedure 

(biopsy) is followed by a more definitive procedure, such as 

Destruction, Excision or Resection at the same procedure 

site, both the biopsy and the more definitive treatment are 

coded. 

Example: Biopsy of breast followed by partial mastectomy at the same 

procedure site, both the biopsy and the partial mastectomy procedure 

are coded. 


36



• 85.11 Closed 

[Percutaneous] [Needle] 

Biopsy Of Breast 

• 85.23 Subtotal Mastectomy 


• 0HBT3ZX Excision of 

Right Breast, 

Percutaneous Approach, 

Diagnostic 

• 0HBT3ZZ Excision of 

Right Breast, 

Percutaneous Approach 


37

Root Operation Guidelines: Overlapping 

Body Layers 

B3.5 

If the root operations Excision, Repair or Inspection are 

performed on overlapping layers of the musculoskeletal 

system, the body part specifying the deepest layer is coded. 

Example: Excisional debridement that includes skin and 

subcutaneous tissue and muscle is coded to the muscle body 

part. 


38


• Assign only a code for the deepest layer of debridement 

when multiple layers of the same site are debrided. 

Coding Clinic, First Quarter 1999 Pages: 8-9 

• As previously stated, when coding multiple layer 

debridements of the same site, the coder should assign a 

code only for the deepest layer of debridement. 

Coding Clinic, Second Quarter 2005 Pages: 3-4 


39


Example: Excisional debridement of skin, subcutaneous tissue, and 

muscle of buttocks. 


• 83.45 Other Myectomy 


• 0KBN3ZZ Excision of 

Right Hip Muscle, 


Or 

• 0KBP3ZZ Excision of 

Left Hip Muscle, 



40

Root Operation Guidelines: Bypass 

Procedures 

B3.6a 

Bypass procedures are coded by identifying the body part 

bypassed “from” and the body part bypassed “to.” The fourth 

character body part specifies the body part bypassed from, 

and the qualifier specifies the body part bypassed to. 


41

Example 

Example: Bypass from stomach to jejunum, stomach is the body 

part and jejunum is the qualifier. 


42


Question: 

A woman with a long-standing history of morbid obesity is 

admitted for laparoscopic gastric bypass with Roux limb. 

The patient was also diagnosed with pelvic peritoneum 

adhesions and ventral hernia and had lysis of adhesions 

and hernia repair. What are the diagnosis and procedure 

code assignments? 

Coding Clinic, Third Quarter 2003 Pages: 6-7 


43



• 44.38 Laparoscopic 

gastroenterostomy 


• 0D164Z9 Bypass Stomach to 

Duodenum, Percutaneous 

Endoscopic Approach 

Or 

• 0D164ZA Bypass Stomach to 

Jejunum, Percutaneous 


Or 

• 0D164ZB Bypass Stomach to 

Ileum, Percutaneous 



44

Root Operation Guidelines: Coronary 

Bypass 

B3.6b 

Coronary arteries are classified by number of distinct sites 

treated, rather than number of coronary arteries or anatomic 

name of a coronary artery (e.g., left anterior descending). 

Coronary artery bypass procedures are coded differently than 

other bypass procedures as described in the previous guideline. 

Rather than identifying the body part bypassed from, the body 

part identifies the number of coronary artery sites bypassed to, 

and the qualifier specifies the vessel bypassed from. 


45

Example 

Example: Aortocoronary artery bypass of one site on the left anterior 

descending coronary artery and one site on the obtuse marginal coronary 

artery is classified in the body part axis of classification as two coronary 

artery sites and the qualifier specifies the aorta as the body part bypassed 

from. 


46

Root Operation Guidelines: Coronary 

Bypass - Multiple Arteries 

B3.6c 

If multiple coronary artery sites are bypassed, a separate 

procedure is coded for each coronary artery site that uses a 

different device and/or qualifier. 


47

Example 

Example: Aortocoronary artery bypass and internal mammary coronary 

artery bypass are coded separately. 


48



• 36.12 

(Aorto)coronary 

bypass of two 

coronary 

arteries 


• 021109W Bypass Coronary Artery, Two Sites to 

Aorta with Autologous Venous Tissue, Open 

Approach 

Or 

• 02110AW Bypass Coronary Artery, Two Sites to 

Aorta with Autologous Arterial Tissue, Open 

Approach 

Or 

• 02110JW Bypass Coronary Artery, Two Sites to 

Aorta with Synthetic Substitute, Open Approach 

Or 

• 02110KW Bypass Coronary Artery, Two Sites to 

Aorta with Nonautologous Tissue Substitute, Open 

Approach 

Note: plus four codes for percutaneous endoscopic 

approach 


49

Root Operation Guidelines: Control vs. 

More Definitive Root Operations 

B3.7 

The root operation Control is defined as, “Stopping, or 

attempting to stop, postprocedural bleeding.” If an attempt 

to stop postprocedural bleeding is initially unsuccessful, 

and to stop the bleeding requires performing any of the 

definitive root operations Bypass, Detachment, Excision, 

Extraction, Reposition, Replacement, or Resection, then 

that root operation is coded instead of Control. 

Example: Resection of spleen to stop postprocedural bleeding is 

coded to Resection instead of Control. 


50

Root Operation Guidelines: Excision vs. 

Resection 

B3.8 

PCS contains specific body parts for anatomical 

subdivisions of a body part, such as lobes of the lungs or 

liver and regions of the intestine. Resection of the specific 

body part is coded whenever all of the body part is cut out 

or off, rather than coding Excision of a less specific body 

part. 

Example: Left upper lung lobectomy is coded to Resection of 

Upper Lung Lobe, Left rather than Excision of Lung, Left. 


51

Example 

Open left upper lung lobectomy 0BTG0ZZ 


52

Root Operation Guidelines: Excision for Graft 

B3.9 

If an autograft is obtained from a different body part in order 

to complete the objective of the procedure, a separate 

procedure is coded. 

Example: Coronary bypass with excision of saphenous vein 

graft, excision of saphenous vein is coded separately. 


53

Root Operation Guidelines: Fusion Procedures 

of the Spine 

B3.10a 

The body part coded for a spinal vertebral joint(s) rendered 

immobile by a spinal fusion procedure is classified by the 

level of the spine (e.g. thoracic). There are distinct body part 

values for a single vertebral joint and for multiple vertebral 

joints at each spinal level. 

Example: Body part values specify Lumbar Vertebral Joint, 

Lumbar Vertebral Joints, 2 or More and Lumbosacral Vertebral 

Joint. 


54


of the Spine (cont) 

B3.10b 

If multiple vertebral joints are fused, a separate procedure is 

coded for each vertebral joint that uses a different device 

and/or qualifier. 

Example: Fusion of lumbar vertebral joint, posterior approach, 

anterior column and fusion of lumbar vertebral joint, posterior 

approach, posterior column are coded separately. 


55

Root Operation Guidelines: Fusion Procedures of 

the Spine (cont) 

B3.10c 

Combinations of devices and materials are often used on a 

vertebral joint to render the joint immobile. 

When combinations of devices are used on the same 

vertebral joint, the device value coded for the procedure is 

as follows: 

• If an interbody fusion device is used to render the joint 

immobile (alone or containing other material like bone graft), 

the procedure is coded with the device value Interbody 

Fusion Device; 

• If internal fixation is used to render the joint immobile and an 

interbody fusion device is not used, the procedure is coded 

with the device value Internal Fixation Device; 

• 


56



B3.10c (cont.) 

• If bone graft is the only device used to render the joint 

immobile, the procedure is coded with the device value 

Nonautologous Tissue Substitute or Autologous Tissue 

Substitute, and 

• If a mixture of autologous and nonautologous bone graft 

(with or without biological or synthetic extenders or binders) 

is used to render the joint immobile, code the procedure with 

the device value Autologous Tissue Substitute. 


57



B3.10c (cont.) 

• Examples: Fusion of a vertebral joint using a cage style interbody 

fusion device containing morsellized bone graft is coded to the 

device Interbody Fusion Device. 

• Fusion of a vertebral joint using a bone dowel interbody fusion 

device made of cadaver bone and packed with a mixture of local 

morsellized bone and demineralized bone matrix is coded to the 

device Interbody Fusion Device. 

• Fusion of a vertebral joint using rigid plates affixed with screws 

and reinforced with bone cement is coded to the device Internal 

Fixation Device. 

• Fusion of a vertebral joint using both autologous bone graft and 

bone bank bone graft is coded to the device Autologous Tissue 

Substitute. 


58

Root Operation Guidelines: Inspection 

Procedures 

B3.11a 

Inspection of a body part(s) performed in order to achieve 

the objective of a procedure is not coded separately. 

Example: Fiberoptic bronchoscopy performed for irrigation of 

bronchus, only the irrigation procedure is coded. 


59



B3.11b 

If multiple tubular body parts are inspected, the most distal 

body part inspected is coded. If multiple non-tubular body 

parts in a region are inspected, the body part that specifies 

the entire area inspected is coded. 

Examples: Cystoureteroscopy with inspection of bladder and 

ureters is coded to the ureter body part value. 

Exploratory laparotomy with general inspection of abdominal 

contents is coded to the peritoneal cavity body part value. 


60



B3.11c 

When both an Inspection procedure and another procedure 

are performed on the same body part during the same 

episode, if the Inspection procedure is performed using a 

different approach than the other procedure, the Inspection 

procedure is coded separately. 

Example: Endoscopic Inspection of the duodenum is coded 

separately when open Excision of the duodenum is performed 

during the same procedural episode. 


61

Root Operation Guidelines: Occlusion vs. Restriction for 

Vessel Embolization Procedures 

B3.12 

If the objective of an embolization procedure is to 

completely close a vessel, the root operation Occlusion is 

coded. If the objective of an embolization procedure is to 

narrow the lumen of a vessel, the root operation Restriction 

is coded. 

Examples: Tumor embolization is coded to the root operation 

Occlusion, because the objective of the procedure is to cut off the 

blood supply to the vessel. 

Embolization of a cerebral aneurysm is coded to the root operation 

Restriction, because the objective of the procedure is not to close off 

the vessel entirely, but to narrow the lumen of the vessel at the site 

of the aneurysm where it is abnormally wide. 


62

Root Operation Guidelines: Release 

Procedures 

B3.13 

In the root operation Release, the body part value coded is 

the body part being freed and not the tissue being 

manipulated or cut to free the body part. 

Example: Lysis of intestinal adhesions is coded to the specific 

intestine body part value. 


63

Root Operation Guidelines: Release 

Procedures vs. Division 

B3.14 

If the sole objective of the procedure is freeing a body part 

without cutting the body part, the root operation is Release. 

If the sole objective of the procedure is separating or 

transecting a body part, the root operation is Division. 

Examples: Freeing a nerve root from surrounding scar tissue to 

relieve pain is coded to the root operation Release. Severing a 

nerve root to relieve pain is coded to the root operation Division. 


64

Root Operation Guidelines: Reposition for 

Fracture Treatment 

B3.15 

Reduction of a displaced fracture is coded to the root 

operation Reposition and the application of a cast or splint in 

conjunction with the Reposition procedure is not coded 

separately. Treatment of a nondisplaced fracture is coded to 

the procedure performed. 

Examples: Putting a pin in a nondisplaced fracture is coded to 

the root operation Insertion. 

Casting of a nondisplaced fracture is coded to the root 

operation Immobilization in the Placement section. 


65

Root Operation Guidelines: 

Transplantation vs. Administration 

B3.16 

Putting in a mature and functioning living body part taken 

from another individual or animal is coded to the root 

operation Transplantation. Putting in autologous or 

nonautologous cells is coded to the Administration section. 

Example: Putting in autologous or nonautologous bone 

marrow, pancreatic islet cells or stem cells is coded to the 

Administration section. 


66

Body Part: General Guidelines 

B4.1a 

If a procedure is performed on a portion of a body part that 

does not have a separate body part value, code the body 

part value corresponding to the whole body part. 

Example: A procedure performed on the alveolar process of 

the mandible is coded to the mandible body part. 

B4.1b 

If the prefix “peri” is combined with a body part to identify the site of the 

procedure, the procedure is coded to the body part named. 

Example: A procedure site identified as perirenal is coded 

to the kidney body part. 


67

Body Part Guidelines: Branches of Body 

Parts 

B4.2 

Where a specific branch of a body part does not have its 

own body part value in PCS, the body part is coded to the 

closest proximal branch that has a specific body part value. 

Example: A procedure performed on the mandibular branch 

of the trigeminal nerve is coded to the trigeminal nerve body 

part value. 


68

Body Part Guidelines: Bilateral Body Part 

Values 

B4.3 

Bilateral body part values are available for a limited number 

of body parts. If the identical procedure is performed on 

contralateral body parts, and a bilateral body part value 

exists for that body part, a single procedure is coded using 

the bilateral body part value. If no bilateral body part value 

exists, each procedure is coded separately using the 

appropriate body part value. 

Examples: The identical procedure performed on both 

fallopian tubes is coded once using the body part value 

Fallopian Tube, Bilateral. The identical procedure performed 

on both knee joints is coded twice using the body part 

values Knee Joint, Right and Knee Joint, Left. 


69

Example 

Example: Laparoscopic bilateral oophorectomy 0UT24ZZ 


70

Example 

Example: Bilateral hip replacement , metal on polyethylene 0SR90J5, 

0SRB0J5 


71

Body Part Guidelines: Coronary Arteries 

B4.4 

The coronary arteries are classified as a single body part 

that is further specified by number of sites treated and not 

by name or number of arteries. Separate body part values 

are used to specify the number of sites treated when the 

same procedure is performed on multiple sites in the 

coronary arteries. 

Examples: Angioplasty of two distinct sites in the left 

anterior descending coronary artery with placement of two 

stents is coded as Dilation of Coronary Arteries, Two Sites, 

with Intraluminal Device. 

Angioplasty of two distinct sites in the left anterior 

descending coronary artery, one with stent placed and one 

without, is coded separately as Dilation of Coronary Artery, 

One Site with Intraluminal Device, and Dilation of Coronary 

Artery, One Site with no device. 


72



• 00.66 Percutaneous 

transluminal coronary 

angioplasty [PTCA] or 

coronary atherectomy 

• 00.40 Procedure on single 

vessel 


• 0270346 Dilation of 

coronary artery, one site, 

bifurcation, with drugeluting 

intraluminal device, 

percutaneous approach 

• 00.45 Insertion of one 

vascular stent 

• 36.07 Insertion of drugeluting 

coronary artery 

stents(s) 

• 00.44 Procedure on vessel 

bifurcation 


73

Body Part Guidelines: Tendons, Ligaments, Bursae 

and Fascia Near a Joint 

B4.5 

Procedures performed on tendons, ligaments, bursae and 

fascia supporting a joint are coded to the body part in the 

respective body system that is the focus of the procedure. 

Procedures performed on joint structures themselves are 

coded to the body part in the joint body systems. 

Examples: Repair of the anterior cruciate ligament of the 

knee is coded to the knee bursae and ligament body part in 

the bursae and ligaments body system. Knee arthroscopy 

with shaving of articular cartilage is coded to the knee joint 

body part in the Lower Joints body system. 


74

Body Part Guidelines: Skin, Subcutaneous Tissue and 

Fascia Overlying a Joint 

B4.6 

If a procedure is performed on the skin, subcutaneous 

tissue or fascia overlying a joint, the procedure is coded to 

the following body part: 

• Shoulder is coded to Upper Arm 

• Elbow is coded to Lower Arm 

• Wrist is coded to Lower Arm 

• Hip is coded to Upper Leg 

• Knee is coded to Lower Leg 

• Ankle is coded to Foot 


75

Body Part Guidelines: Fingers and Toes 

B4.7 

If a body system does not contain a separate body part 

value for fingers, procedures performed on the fingers are 

coded to the body part value for the hand. If a body system 

does not contain a separate body part value for toes, 

procedures performed on the toes are coded to the body 

part value for the foot. 

Example: Excision of finger muscle is coded to one of the 

hand muscle body part values in the Muscles body system. 


76

Approach Guidelines: Open Approach with 

Percutaneous Endoscopic Assistance 

B5.2 

Procedures performed using the open approach with 

percutaneous endoscopic assistance are coded to the 

approach Open. 

Example: Laparoscopic –assisted sigmoidectomy is coded to the 

approach Open. 


77

Approach Guidelines: External Approach 

B5.3a 

Procedures performed within an orifice on structures that 

are visible without the aid of any instrumentation are coded 

to the approach External. 

Example: Resection of tonsils is coded to the approach 

External. 

B5.3b 

Procedures performed indirectly by the application of external 

force through the intervening body layers are coded to the approach 

External. 

Example: Closed reduction of fracture is coded to the 

approach External 


78

Approach Guidelines: Percutaneous 

Procedure via Device 

B5.4 

Procedures performed percutaneously via a device 

placed for the procedure are coded to the approach 

Percutaneous. 

Example: Fragmentation of kidney stone performed via 

percutaneous nephrostomy is coded to the approach 

Percutaneous. 

. 


79

Device Guidelines 

B6.1a 

B6.1b 

B6.1c 

B6.2 

A device is coded only if a device remains after the procedure is completed. If 

no device remains, the device value No Device is coded. 

Materials such as sutures, ligatures, radiological markers and temporary 

post-operative wound drains are considered integral to the performance of a 

procedure and are not coded as devices. 

Procedures performed on a device only and not on a body part are specified 

in the root operations Change, Irrigation, Removal and Revision, and are 

coded to the procedure performed. 

A separate procedure to put in a drainage device is coded to the root 

operation Drainage with the device value Drainage Device. 


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Understanding the ICD-10-PCS Guidelines - ACSS

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